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Month: October 2017

There is a unique and fragile relationship between all the structures of our hands. An injury or disease affecting any of the bones, ligaments, tendons, nerves, skin, joints, or blood vessels can completely restrict the use of our hands, wrists, forearms, and even our elbows. Knowing the multitude of purposes they serve, including eating, dressing, and performing our jobs, when trauma occurs it can be disabling and frustrating. Injury can be caused by work-related accidents or repetitive use of the fingers and extremities. If spending time doing hobbies or performing normal daily routines are interrupted by extremity pain, it is probably time you seek medical advice from hand surgeons.

An estimated 16 million people in the U.S. seek out care for fist-related injuries each year. These hand surgeons are required to obtain an additional year of specialized training beyond their board certifications for orthopedic surgery, plastic surgery, and general surgery. The need for this exclusive medical training dates back to World War II, when many soldiers sustained hand-related injuries and required military surgeons to obtain additional training. Up until this point, injuries and wounds rarely healed properly due to a lack of appropriate care.

A majority of these physicians also carry expertise in dealing with issues related to the arms, shoulders, and elbows. Common ailments these doctors treat are

– Sports-related injuries of the extremities and wrists
– Fractures, including in the wrists and forearms
– Tennis elbow
– Amputations
– Creating fingers from toes and other joints
– Carpal Tunnel Syndrome
– Arthritis, including that of the wrists and elbows
– Lumps on the hands and arms
– Tumors causing tingling, pain, and numbness
– Injuries to the nerves and tendons
– Congenital limb differences (birth defects)

A common misconception is that this field deals strictly with surgery. Hand surgeons try to heal a patient without resorting to surgery and often recommend non-surgical treatments including splints, physical therapy, injections, ice therapy, rest, and medications. Should surgery be necessary, it can be performed under either general or regional anesthetics. Over 90 percent of these procedures are performed under local anesthesia, where you receive an injection in your arm or upper chest area to numb the nerves running to the arm. Delays in both diagnosis and treatment can cause a reduction in your range of motion and even long-term disability. The gravity of these injuries is why as soon as pain or discomfort is felt in any of the lower extremities, you should consult a doctor.

Despite the high demand for these physicians, it is not an attractive surgical field of study. For a newly graduated medical students, the best route to landing positions as hand surgeons by working within that related medical environment. Additionally, internships often lead to secured positions within this field because the candidate has already gained insight into this specialty. These doctors are employed either in a private practice or within hospitals or clinics.

Research has shown that using your non-dominant hand will grow brain cells and also enhance your creativity. I’m glad to know this, because I’m going to be testing this very soon.

I need to have surgery on my right shoulder- and my right hand is my dominant hand. I’ve been cautioned that I won’t be able to use my right hand at all for two weeks and that my right arm will be in a sling for a number of weeks.

Since I injured myself over six months ago, I have been using my left arm as much as possible, simply because my right arm hurts so badly. However, in recent months I’ve started to practice using my left hand with greater intentionality to perform those daily tasks that, until now, I have always taken for granted: dress, brush my teeth, make food, pour liquids, give my cat his medicine, collect my vitamins, scoop cat litter, bathe, carry things, etc.

I have yet to practice writing and eating with my left hand, but since my surgery is less than a week away, I’d better get to it.

Web research and wise friends and family have given me terrific suggestions to help me weather this unfortunate but necessary right hand and right arm hiatus. For example, a water pick and an electric toothbrush make teeth cleaning a lot easier.

I know that slip on shoes and button down shirts are a must- as is a recliner, since I won’t be able to sleep in a bed (or get in and out of a bed) for one or two months.

I love to do Sudoku and I just learned that I can do it with my left hand on an iPad, since I can enter the numbers with one of my fingers. Sudoku is one of the ways I relax and I’m so glad I won’t have to give it up.

Over the past six months, I have learned to make accommodations. I have primarily used my left arm to carry heavy things- although my adult children and friends have taken over most of my weighty needs.

My son empties my car and carries in groceries and three 40-pound bags of cat litter at a time into the house. He has taken over filling the six bird feeders, carrying out the garbage and mowing my lawn.

My daughter pushes and fills the grocery cart and cuts whole watermelons for me. I’m very lucky that they both live relatively close to me.

Kind friends and colleagues have carried my training materials and helped me set up training rooms: moving tables and chairs, putting the kites up on the walls, filling the candy bowls and putting them on the tables, distributing table top and participant materials, etc. I could never have managed to keep conducting training programs over this past half year without their wonderful support.

How did I hurt my shoulder? I pulled four very heavy pieces of luggage through an airport on my way to Jordan and Dubai and apparently tore a tendon. I also have a torn rotator cuff and an impingement (essentially bone scraping on bone).

During the course of traveling on different planes and having to climb up steep stairs to board them, I further aggravated and inflamed my arm and shoulder. I quickly learned to ask people around me to help me go up stairs or stow luggage up above my seat. I literally had no choice.

My surgeon wanted to schedule my surgery much sooner, but I had training commitments I needed to fulfill. Even now, I am sorely (!) tempted to put off the surgery even longer because I worry about being unable to do my work. However, there will never be a perfect time, so I’ll just have to handle it now.

When I ask myself what I am supposed to learn from this situation, there are a number of answers that pop into my mind. Here they are, in no particular order:

1. It is often all right and sometimes mandatory to ask others for help. I am so lucky to have friends and family to help me through this.

2. It will be a good experiment in neuroplasticity to see if using my non-dominant hand will make me smarter and increase my creativity. Those would be wonderful and welcome side effects!

3. Acting as if I am strong like a bull has gotten me into this predicament. When I travel for work in the future, I will box and mail materials ahead and make sure to use a porter for any and all luggage

4. As much as I absolutely hate to acknowledge this fact of life, I am older and need to be more realistic about my physical capabilities and more diligent in properly accommodating my physical limitations.

5. It will be a test of my self-discipline to resist the gravitational pull of my desk for two full weeks. Creating materials and articles has been a daily habit for decades.

6. When I don’t listen to my body, it eventually does something so dramatic that I have to pay attention. I need to finally learn and remember this lesson.

7. I have always prided myself on my independence. Now I need to recognize and accept that there is no shame when I have to rely on others.

8. Knowing that I will be sidelined for a while has prompted me to become better at setting limits and managing expectations- for myself and for my clients.

9. If my pain is not taken seriously by medical professionals in the future, I will not hesitate to demand an MRI!! Early diagnosis would have saved me six months of agony.

10. To everything there is a season, and this is my time to rest and heal. I plan to come back smarter and stronger!

If you’re living with chronic hand or wrist pain, chances are you desperately want relief. Many times, non-surgical treatment is quite effective as a remedy for hand and wrist pain. However, there are circumstances in which hand surgery is the only long-term solution.

So when is it time to consider undergoing hand surgery for your carpal tunnel syndrome, rheumatoid arthritis, or other hand condition?

When Do I Need Carpal Tunnel Surgery?

You might be suffering from carpal tunnel syndrome if you have:

Numbness or tingling in the thumb, index, middle, or half the ring finger

Pain relief is the main purpose for performing most hand surgeries, including carpal tunnel release surgery. Individual pain thresholds vary, so some individuals let the condition progress further than others before they consider hand surgery. In most cases, carpal tunnel patients decide that hand surgery is necessary when they start experiencing numbness in the fingers, severe nighttime pain, and radiating hand pain.

There are three different surgical options to address carpal tunnel pain:

Rheumatoid arthritis has no known cure. This is a chronic inflammatory, autoimmune disorder, meaning the body’s immune system mistakenly attacks its own tissues. Because of this, rheumatoid arthritis treatments mainly focus on controlling symptoms and preventing joint damage.

You might have rheumatoid arthritis if you are experiencing:

Tender, warm, swollen joints

Morning stiffness that can last for hours

Rheumatoid nodules – firm bumps of tissue under the skin on the arms

Fatigue, fever, weight loss

Since there is no absolute cure for rheumatoid arthritis of the hand, medications can reduce joint swelling, relieve pain, and prevent or slow joint damage, but very little else.

The best treatment is to manage rheumatoid arthritis symptoms as best as possible from early on. Being proactive in this way will hopefully prevent or slow irreparable damage to your hands.

Unfortunately, many who suffer from hand and wrist arthritis don’t take action until they feel significant pain and the damage has already begun. Severely damaged joints due to rheumatoid arthritis of the hand make hand surgery necessary.

If medications and other treatments fail to prevent joint damage from rheumatoid arthritis, there are several surgical procedures to consider:

Total joint replacement – Damaged parts of joint are removed and replaced with a prosthesis made of metal or plastic

Tendon repair – Surgical repair of the tendons around joints that may have loosened or ruptured

Joint fusion – For when joint replacement is not an option; two joints may be fused together to stabilize or realign a joint, often resulting in pain relief

It is difficult to regain full function of the fingers after damage from rheumatoid arthritis, but significant improvement in function, pain, and appearance can be expected after this kind of hand surgery. Removal or repair of the arthritic areas will not remove the cause of the disease, meaning problems can return, which will require additional attention from your hand doctor.

Is There a Surgery to Remove Ganglion Cysts?

Ganglion cysts are very common and usually appear on the wrist. The cyst is a pocket of fluid that has built up on a weak spot of the ligament wall. Ganglion cysts are almost always benign, meaning they are non-cancerous.

In general, ganglion cysts do not cause pain or limit a person’s range of motion. Of course, this is not always the case. In some individuals, cysts like these can become chronically painful and must be treated.

The least aggressive treatment for a ganglion cyst is rest. It is recommended for those who are not experiencing pain or discomfort from their cyst. A hand doctor will recommend immobilization of the cystic hand or wrist, either with or without a splint. Ganglion cysts can go away on their own, but only with time.

The next, more aggressive option is aspiration, which simply means draining the cyst of built-up fluid. A hand doctor, who will use a needle and syringe to draw out fluid contained in the cyst, performs this procedure using local anesthesia. Aspiration is a good temporary solution with little to no recovery time. However, the cyst is likely to reappear, as the “root,” or the sac, will eventually heal where it has been punctured and begin to fill up again gradually.

Surgical excision is the most thorough treatment option for getting rid of a ganglion cyst. Patients who resort to hand surgery usually do so because their ganglion cyst has become painful or uncomfortable. Close proximity to a nerve, for example, could cause a great deal of discomfort and pain, especially with range of motion.

Surgical excision, performed by a hand doctor, usually only takes about 20-30 minutes. This method has the least chance of the cyst re-forming. This is because the root, or the sac, trapping the fluid is completely removed so that it cannot close and fill up again.

Ultimately, they are your hands and wrists, and you only get one pair, so take care of them! It may be easier to ignore pain when it first appears, but visiting a hand doctor right away for your condition could ultimately save you from needing surgery to correct the damage.

Hopefully you’ve been heeding my advice and you’ve gone to see your doctor about your hand pain. I’m going to guess that if he told you that he thinks you have carpal tunnel syndrome, he probably gave you a brace (or splint) and told you to come see him in a month. Hopefully he has referred you to a hand therapist or hand surgeon, and now you’re just waiting to see what happens next. Don’t panic. Once you understand what’s involved, I think you’ll feel a lot better.

So, let’s talk about that. What IS next?

First of all, let’s talk about what carpal tunnel syndrome really involves. Because if there is something that I’ve learned over the years, it’s that people don’t get a good explanation of what is really going on inside their hand. And as I always say, knowledge is power.

Your “carpal tunnel” is a space in the base of your palm that is formed by several wrist bones and a thick ligament. Imagine it like this: Make an “O” shape between your thumb and your index finger. Now, hold your arm in a way that forces your palm to be facing the ceiling. The bottom half of the circle is a group of bones. The top half of the circle is a ligament. You’ve just created a mock-up carpal tunnel.

Through that “tunnel”, you have several tendons (that make your fingers bend) and one very important nerve that operates your thumb muscles and also gives you sensation to your thumb, index, middle, and part of your ring finger. Over time, if those tendons swell, they will crush the nerve against the wall (which is the ligament we talked about earlier) and that pinches the nerve, forcing it to stop working well. Usually, your first symptom is numbness or tingling, then hand pain at night, and eventually you start dropping things because your thumb is getting weaker (and you can’t feel properly).

This information is good to have so that you understand WHY the doctor wants you to wear a splint. See, when you bend your wrist in either direction, you pinch the (already irritated) tunnel more, which cuts off the nerve supply and makes your symptoms worse. The purpose of the splint is to keep your wrist “straight” so that the tunnel is as open as possible. Sometimes a splint is all you need to completely recover. Problem solved!

Go ahead and make that “O” again with your thumb and index finger. Now leave a slight gap where your fingers should be touching. When a surgeon performs a carpal tunnel release, he is simply cutting that ligament in half so that it relieves the pressure that has been squishing the nerve. He doesn’t remove anything. He just opens up the space so that your nerve can “breathe” again. Easy peasy! You will usually have to take it easy for a few weeks, and maybe spend another few in therapy, but after that, you are as good as new!

See? That’s not so bad.

Not sure what your condition is? The quiz at [http://www.handpain.co/quiz] will tell you what your condition is and what to do about it.